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SCS > The Young Athlete > Flashcards

The Young Athlete Flashcards

1
Q

What are some differences between Adult and Growing Bone?

A
  • Articular cartilage of growing bone is thicker and can remodel
  • Junction between epiphyseal plate and the metaphysis is vulnerable to disruption, especially shearing forces
  • Tendon attachment sites - apophyses - provide a relatively weak cartilaginous attachment, predisposing avulsion injuries
  • Metaphysis of long bones in children is more resilient and elastic, predisposing to greenstick fractures
  • During growth spurt, epiphyseal plate is more fragile leading to increased incidence of physeal fractures in pubescence
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2
Q

What are the three most common types of fractures seen in the young athlete?

A
  • Metaphyseal
  • Epiphyseal Growth Plate
  • Apophyseal Avulsion Fractures
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3
Q

What is the most common metaphyseal fracture in young athletes

A
  • Buckling in either forearm or lower leg

- Known as greenstick

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4
Q

What is the treatment for greenstick fractures?

A
  • If no growth plate involvement
  • Immobilization, heals in three weeks
  • Sometimes angular or rotational deformity requires ORIF
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5
Q

Name the Site of Osteochondrosis associated with: Perthes, Kienbocks, Kohlers, Freibergs, and Osteochondritis Dissecans (Articular)

A
  • Femoral Head
  • Lunate
  • Navicular
  • Second Metatarsal
  • Medial Femoral Condyle, Capitellum, talar dome
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6
Q

Name the site of Osteochondrosis associated with Osgood Schlatter, Sinding Larsen Johansson, and Severs lesions (Non Articular)

A
  • Tibial Tubercle
  • Inferior Pole of Patella
  • Calcaneus
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7
Q

Name the site of Ostechondrosis associated with Sheurmanns and Blounts Lesions (Physeal)

A
  • Thoracic Spine

- Proximal Tibia

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8
Q

Describe the Salter Harris Classification of Growth Plate Fractures (Physeal)

A
  • S - Slipped
  • A - Above (growth plate)
  • L - Lower
  • T - Through
  • ER - Erasure (of growth plate, crushed)
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9
Q

How well do the different classifications of Salter Harris Fractures Heal?

A
  • 1 and 2 heal well

- 3 and 4 involve joint surface and growth plate and have high complication rate

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10
Q

What history best describes growth plate fracture?

A
  • Severe rotational or shear force with accompanying localized swelling, bony tenderness, and loss of function
  • Orthopedic referral mandatory
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11
Q

What type of avulsion fracture can occur in children accompanying ACL injury?

A
  • Avulsion of tibial spine or the Distal Femoral Attachment
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12
Q

What is the most commonly reported acute apophyseal sports injury in the upper extremity? In the Spine?

A
  • Injury to the olecranon and medial epicondyle of humerus

- in Spine it is the vertebral ring apophysis

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13
Q

How are avulsion fractures in the young athlete treated?

A
  • Same as grade 3 tears of muscle
  • Reduce pain and swelling
  • Restore full ROM with passive stretching and active ROM as symptoms settle
  • Graduated return to strength training
  • Reattachment is rarely necessary
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14
Q

Are dislocations of the glenohumeral joint common in the younger child?

A
  • No, but common in the adolescent
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15
Q

What are the radiographic signs of Stress fracture of the proximal humeral epiphyseal plate?

A
  • Widening of the proximal humeral epiphysis
  • Metaphyseal sclerosis and demineralization or fragmentation of the epiphysis
  • Most improve with rest and return to sport
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16
Q

What causes shoulder impingement in the younger athlete?

A
  • Secondary to atraumatic instability
  • Because of repetitive stress to anterior capsule of the shoulder
  • Also occur in swimmers where excessive IR causes a tendency to impinge
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17
Q

What types of elbow pathology may be caused by forceful valgus stress in pitching?

A
  • Medial stretching, Lateral Compression, and Posterior Impingement can cause:
  • Apophysitis of the epicondyle
  • Chronic strain of medial (ulnar) collateral ligament
  • Avulsion fracture of the medial epicondylar apophysis
  • Ulnar Nerve damage
  • Lateral compressive forces in particular may damage articular cartilage of the capitellum or radial head
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18
Q

Which individuals experience Osteochondritis Dissecans of the Capitellum? Treatment?

A
  • Gymnasts
  • Pitchers
  • Early stages respond well to rest
  • Loose bodies (if any) need surgery to remove
  • Results of surgery are variable
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19
Q

Describe a Panners Lesion

A
  • Occurs in younger child (under 11 years)
  • Self limiting
  • Fragmentation of the entire ossific center of the capitellum
  • No loose bodies, no surgery required
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20
Q

What is a common cause of dorsal wrist pain in the young gymnast?

A
  • Compromise of blood supply of the distal radial physis
  • Aggravated by weight bearing
  • On radiographs: widening, irregularity, haziness, or cystic changes within growth plate
  • Other causes include scaphoid impaction syndrome, dorsal impingement, TFCC tear, stress fractures
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21
Q

What is a Kienbocks Lesion?

A
  • Osteochondrosis of lunate

- Usually in older patients (over 20)

22
Q

What is treatment for stress injuries of the distal radial physis in the young athlete?

A
  • Rest

- However, premature closure can occur resulting in positive ulnar variance

23
Q

What is the most common postural abnormality of the spine in the younger athlete?

A
  • Scheuermanns Lesion
24
Q

What is a Scheuermanns Lesion?

A
  • Excessive kyphosis of the spine due to osteochondrosis

- Usually in thoracic spine but also at thoracolumbar junction

25
Q

How is the radiologic diagnosis of Scheuermans Lesion Made?

A
  • Presence of wedging of 5 degrees or more on 3 adjacent vertebrae
26
Q

What is the management of Scheuermans Lesion in the young athlete?

A
  • Aimed at preventing progression
  • Joint mobilization, massage, stretching of hamstrings and abdominal strengthening
  • Brace may be worn
  • Surgery indicated if kyphosis greater than 50 degrees or signs of spinal cord irritation are present
27
Q

What are the sites of apophysitis around the hip joint?

A
  • ASIS - Sartorius
  • AIIS - Rectus Femoris
  • Lesser Trochanter - Iliopsoas
28
Q

Describe Perthes Disease and its presentation

A
  • Osteochondrosis of femoral head
  • Ages 4-10
  • Presents with limp or low grade ache in the thigh
  • Unilateral
  • Limited Abduction and Internal Rotation
  • More common in males
  • Radiographs show increased density and flattening of the femoral capital epiphysis
29
Q

What is management of Perthes Disease?

A
  • Rest
  • ROM exercises to maintain Abduction and IR
  • If severe may require arthroscopic chondroplasty and loose body removal
  • Main long term concern is Osteoarthritis due to irregularity of the joint surface
30
Q

Describe Slipped Capital Femoral Epiphysis and its presentation

A
  • Ages 12-15
  • Usually in overweight boys who tend to be late maturing
  • Most common presenting symptom is limp, sometimes pain in the knee
  • Shortening and External Rotation of the affected leg
  • Hip Abduction and IR are reduced
  • Bilateral Involvement common
  • Radiographs show widening of growth plate
31
Q

What is treatment of Slipped Capital Femoral Epiphyses?

A
  • Gradually progressing slip is indication for surgery
  • Acute severe slip is surgical emergency
  • Can lead to Avascular Necrosis
32
Q

What may be an anatomical predisposing factor to the development of Osgood Schlatter?

A
  • Excessive Subtalar Pronation
33
Q

What is a Sinding Larsen Johannson Lesion?

A
  • Apophysitis of inferior patellar pole
  • Prevalent in junior basketball players
  • Self limiting and treated with rest
34
Q

Describe Osteochondritis Dissecans of the Knee

A
  • Presents with intermittent pain and swelling of gradual onset
  • May present as acute painful and locked knee (Associated with hemarthrosis and loose bodies)
  • Radiographs reveal defect at lateral aspect of Medial Femoral Condyle
  • Ortho referral for fixation of loose fragment or removal of detached fragment
35
Q

Describe Stills Disease

A
  • Juvenile Rheumatoid Arthritis of the knee
  • Persistent intermittent effusion with increased temperature and limited ROM
  • May be family history of RA
  • Needs serological examination including Rheumatoid factor, ESR, and maybe examination of joint aspirate
  • Treatment is activity modification
36
Q

Describe Diagnosis of Acute Rheumatic Fever?

A
  • May or may not be history of sore throat and Carditis
  • Must maintain high index of suspicion
  • Investigations include markers of inflammation (ESR, C reactive protein), Serology for Streptococci, and echocardiography
  • Treatment is Oral Penicillin and Aspirin
37
Q

Describe a Discoid Meniscus

A
  • May cause persistent knee pain and swelling in the adolescent athlete
  • Marked Joint Line Tenderness
  • History of clunking in the younger child (4 years)
38
Q

Describe Adolescent Tibia Vara (Blounts Disease)

A
  • Affects proximal tibial growth plate
  • Affects tall, obese children around the age of 9
  • Usually Unilateral
  • Radiographs show a reduced height of the medial aspect of the proximal tibial growth plate
  • May require surgery to correct mechanical abnormality
39
Q

What are some Risk Factors for Females tearing an ACL?

A
  • Being in pre-ovulatory phase of menstrual cycle vs post-ovulatory phase
  • Decreased intercondylar notch width
  • Increased knee abduction moment on impact on landing
40
Q

When is non operative management suggested for children with ACL injury?

A
  • Children who have not yet reached skeletal maturity (Tanner stages 1 and 2, Prepubescents)
  • Poor Outcome
41
Q

When is surgery recommended for children with ACL injury?

A
  • Children who are non compliant with management
  • Demonstrating functional instability with ADLs
  • Associated Meniscal Pathology
  • Usually use Autologous IT Band graft
42
Q

What is a Severs Lesion?

A
  • Apophysitis of the Calcaneus at the insertion of the achilles
  • Patient complains of localized pain with activity
  • Tenderness at insertion of achilles
  • May be tightness of gastrocnemius or soleus
  • May be limited dorsiflexion
43
Q

What is management of Severs Lesion?

A
  • Activity Modification
  • Heel Raise
  • Calf Stretching
  • Strengthening to plantar flexors when pain free and symptoms permit
44
Q

What are common Tarsal Coalitions?

A
  • Most common form is a bony or cartilaginous bar between the navicular and calcaneus
  • Second is between calcaneus and talus
  • Calcaneocuboid is least common
45
Q

What is presentation of Tarsal Coalition?

A
  • Midfoot pain after recurrent ankle sprains or after repetitive running and jumping
  • May have a limp
  • Restriction of Subtalar Joint Motion
  • Radiographs taken at 45 degree oblique may confirm
  • If negative but clinical suspicion is high, MR or CT
46
Q

What is treatment of Tarsal Coalition?

A
  • Orthotic Therapy
  • Surgical excision in younger patient with severe symptoms
  • Coalition may recur after surgery
47
Q

What is a Kohlers Lesion? Presentation?

A
  • Osteochondrosis affecting navicular bone in young children
  • Ages 2 to 8
  • Pain over medial aspect of navicular
  • Radiographs show increased density and narrowing of navicular bone
48
Q

What is treatment of Kohlers Lesion?

A
  • Waling Cast for Six Weeks to accelerate relief

- Orthoses if biomechanical abnormalities are present

49
Q

Describe Apophysitis of the Tarsal Navicular Bone

A
  • May cause pain on the medial aspect of the tarsal navicular at insertion of tibialis posterior tendon
  • Often associated with the presence of an accessory navicular or prominent navicular tuberosity
  • Management includes activity modification, NSAIDs, and orthoses to control excessive pronation if present
50
Q

Describe Apophysitis of the Fifth Metatarsal

A
  • Traction apophysitis at insertion of Peroneus Brevis at base of fifth metatarsal
  • Localized tenderness and pain on resisted eversion of the foot
  • Manage with activity modification and stretching and strengthening of the peroneals
51
Q

Describe Freibergs Lesion

A
  • Osteochondrosis causing collapse of the articular surface and adjacent bone on the metatarsal head
  • Second Metatarsal most commonly involved (ballet dancers)
  • Most frequently in adolescents over age of 12
  • Standing on forefoot aggravates pain
  • Tenderness and swelling around second metatarsal joint
  • Radiographs reveal a flattened head of metatarsal with fragmentation of the growth plate
52
Q

What is treatment of Freibergs Lesion?

A
  • If caught early, activity modification, padding under metatarsal, and footwear modification to reduce pressure over metatarsal heads
  • If symptoms persist, surgery

SCS (36 decks)

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